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Reproductive Health






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Health

According to WHO (1948) health is defined as
" Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity."
Health is affected by:
  • Genetic disorder and deficiency with which an individual is born.
  • Infections
  • Lifestyle that include
    1. Food and water
    2. Rest
    3. Exercise
    4. Habits

Reproductive health: problems and strategies


According to WHO, reproductive health means a total well-being in all aspects of reproduction i.e. physical, emotional, behavioral and social.
A reproductively healthy society with people having physically and functionally normal reproductive organs and normal emotional and behavioral interaction among them in all sex- related aspects.
The major tasks of these programmes are:
Creating awareness among the people about various reproduction released aspects.
Providing facilities and support for building up a reproductively healthy society.

Programmes involved in maintaining reproductive health:


  • Family planning programmes
  • Reproductive and child health care (RCH)

AIMS OF REPRODUCTIVE HEALTH PROGRAMMES

  • To provide sex education in the schools to safeguard young school girls from myths and misconceptions about sex- related issues.
  • To prevent and control sexually transmitted disease (STDs) by providing proper information about reproductive organs, adolescence and safe and hygienic sexual practices.
  • To educate the fertile couples and those in marriageable age-group about birth control measures, prenatal and postnatal care of mother and child, importance of breast feeding for a few months etc.
  • To provide medical facilities and support.
  • To manage disorders related to reproductive systems.
  • To lessen the problems of infertility by promoting assisted reproductive activities (ARTs)

Significance of studying human population

Population education has been introduced into the education system of the country to make the students aware of:
  • The consequences of uncontrolled population growth.
  • Advantages of small family norms.
  • The growth, distribution and density of population. The relationship between the population and the standard of life.
  • Methods of control of human population growth.

Determination of Human- Population Growth Rate:

Annual avg. growth rate is the percentage of increase in population size per year.
It can be calculated with the help of following equation:
Annual Growth Rate % =$\left(\frac{P_2-P_1}{P_1\times\ N}\right)\ \times\ 100$
Here P1 – Population size of previous census
P2 - Population size of current census
N – No of years between the two census

Factors Determining Growth Rate:

  • Birth rate (natality rate)
  • Total fertility rate (TFR)
  • Replacement rate
  • Death rate (mortality rate)
  • No. of female individuals in active.
  • Emigration and immigration.

Population explosion

Increased health facilities and improvement in technology leading to better living conditions, have an explosive impact on the growth of population.
The world population was about 2 billion in 1900 A.D.and it is 6 billion in 2000 A.D.
The same trend is observed in India also, our population at the time of independence was about 350 million and it has reached 1 billion in 2000 A.D.(it has crossed 1 billion in May 2000 A.D.)
The probable reason are:
  • Decline in death rate
  • Decline in maternal mortality rate (MMR)
  • Decline in infant mortality rate (IMR)
  • Increase in the no. of people in the reproductive age.



METHODS TO CONTROL OVER POPULATION
  • Education:
People, particularly those in reproductive age group should be educated about the advantage of small family and ill effects of large family and over-population.
In this, mass media like radio, television, newspaper, magazine, posters etc. and educational institution can play important role.
  • Age of marriage: should be raised
  • Family planning methods:
In 1976, Indian govt. thought of introducing a programme of compulsory sterilization, which requires one parent to undergo sterilization (infertile) after a couple, had produced two children.
But due to public resistance, this programme was again changed to voluntary programme.
In India, lack of female literacy, a high fertility rate and low uses of contraceptives are probably the foremost reason for lack of success in population control programmes.


Birth control methods

The most important steps to control population growth is to motivate smaller families by using contraceptive methods.
Other steps include:
  • Raising of marriageable age to 18 for females and 21 for males.
  • Incentive given to couples with small families.
  • An ideal contraceptive should be:
  1. User friendly
  2. Easily available
  3. Effective
  4. Reversible with no or least side effect.
  5. Non- interfering with the sexual drive/ desire and the sexual act of the user.
Methods of Birth Control:
The contraceptive methods are grouped into the following categories:
  • Natural method
  • Barrier methods
  • Intra- uterine devices (IUDs)
  • Oral contraceptives
  • Injectable and Implants
  • Surgical Methods.
Natural Methods:
These methods work on the principle of avoiding changes of meeting between the gametes.
Periodic abstinence:
In this method, the couples avoid or abstain from coitus from day 10th to 17th of the menstrual cycle, when ovulation is expected to occur and chances of fertilisation are very high.
Coitus Interruptus
In this method, the penis is withdrawn from the vagina before ejaculation and insemination is avoided.
Lactational amenorrhea
  • It refers to the absence of menstruation, the period of lactation following parturition.
  • As ovulation does not occur in this period chances of conception are almost nil, but this is effective for a maximum period of six months following parturition.
Barrier methods
The ovum and sperms are prevented from coming closer with the help of barriers.
Such barriers are available for both males and females.
Condoms are the barriers made of thin rubber or later sheath, to cover the penis in males or vagina and cervix in females, condoms also provide protection against sexually transmitted diseases.
Diaphragms, cervical caps and vaults are the barriers (made of rubber), used by females, they are reusable. Spermicidal creams jellies and foams are usually used along with these barriers to increase their contraceptive efficiency.

Condom for male

Condom for Female

Intra- uterine devices
These are the devices introduced into the uterus.
IUDs are of the following types:
  • Non-Medicated IUDs Example Lippes loop.
  • Copper releasing IUDs example .CuT, Cu-7, Multiload-375
  • Hormone releasing IUDs Example . Progestasert, LNG-20
They delay, alter/ inhibit ovulation and implantation or conception in the following ways.
  1. By increasing phagocytosis of sperms within the uterus.
  2. By suppressing sperm motility and thereby suppressing the fertilizing ability of sperm by Cu ion releases by some IUDs.
  3. Hormone releasing IUDs make the uterus unsuitable for implantation and the cervix hostile to the sperms.

Copper T (CuT)
Oral Contraceptives:
These are hormonal preparation in the form of ‘pills’.
They are either progestogens and progesterone-estrogen combinations.
They alter/ inhibit ovulation and implantation and also modify the quality of cervical mucus to prevent/ retard entry of sperms.
Saheli is an example of oral-contraceptive that contains a non- steroidal preparation called ‘Centchroman’. It is a once a week pill.
Oral contraceptive pills have to be taken daily for a period of 21 days starting within the first 5 days of menstrual cycle.

Injectables and Implants:
Progestogens or progestogens -estrogen combination is also used as injections or implants under the skin.
Though their mode of action is similar to oral contraceptives, their periods are longer.

Surgical Methods:
These are advised as a terminal method to prevent only pregnancy.
Surgical methods block the transport of gametes and thereby conception.
Vasectomy: It is the sterilization procedure in males where a small portion of vas deferens is removed or tied up through an incision on the scrotum.

Vasectomy

Tubectomy: it is the sterilization procedure in females where a small part of the fallopian tube is removed or tied up through a small incision in the abdomen or through vagina.

Tubectomy

Medical Termination of pregnancy (MTP)

  • MTP has been legalized by the govt. of India in 1971 with strict conditions to avoid its misuse especially in discriminate and illegal female foeticides .
  • MTP is essential where pregnancy could be harmful to the mother or the Foetus or both.
  • MTP are safe during the first trimester (upto 12 weeks of pregnancy) where as MTPs during the second trimester are risky.
  • MTP or induced abortion is the termination of pregnancy before the Foetus become viable.

Significance:
  • MTPs play a significant role in decreasing human population.
  • It helps in getting rid of unwanted pregnancies and such pregnancies which may be harmful or even fatal either to the mother or to the Foetus or both.
Drawbacks:
  • It has raised many emotional, ethical, religious and social issues.
  • Majority of MTPs are performed illegally by unqualified quacks which are not only unsafe but could be fatal too.
  • It is being misused to abort even the normal female fetuses.


Sexually Transmitted Diseases (STDs)

  • Diseases or infections which are transmitted through sexual intercourse are collectively called STDs or venereal disease (VD) or reproductive tract infections (RTI).
  • Gonorrhea, syphilis, genital herpes chlamydiasis, genital warts, trichomoniasis, hepatitis B and AIDS are some of the common STDs.
  • Of these, the three viral infections ie. AIDs, Genital Herpes and Hepatitis-B cannot be cured while others are curable.
  • The early general symptoms include the following in the genital region.
    1. Itching
    2. Fluid discharge
    3. Slight pain
    4. Swelling
  • The infected persons do not seek medical help for the following reasons:
    1. Absence or less-significant symptoms in the early stage of infections.
    2. Social stigma attached to STDs.
  • These diseases are reported to be high among individuals of the age group of 15-24 years.
  • These infections could be avoided / prevented by following practices:
    1. Avoiding sex with unknown partners or multiple partners.
    2. Using condoms during coitus every time.
    3. Seeking medical help in case of doubt and getting it completely cured.

Infertility

  • It is the inability to conceive or produce children even after 2 years of unprotected sexual relation.
  • The reasons for infertility could be physical, congenital disease, use of certain drugs, immunological reactions or even physiological reactions.
  • Specialized health care units called infertility clinics could diagnose the problem and given corrective treatment for many of those problems.
  • Where corrective treatments are not available, there are special techniques called Assisted Reproductive Technologies (ARTs) to help the couple to produce children.
They are as follows:
1.Test tube baby programmes:
  • In this method, ova from the wife or a donor female and sperm from the husband or donor male are allowed to fuse under stimulated conditions (as that of the body) in the laboratory. This is called in vitro fertilization (IVF).
  • The zygote or early embryo is transferred in to the uterus or fallopian tube for further development. This process is called embryo transfer (ET) and can be done in following ways: (i) Zygote/ Embryo up-to 8 blastomeres is transferred into the fallopian tube, it is called zygote intra fallopian transfer (ZIFT).
    (ii) Embryos with more than 8 blastomeres are transferred into the uterus, it is called intra- uterine transfer (IUT).

2. Gamete intra fallopian transfer (GIFT)
  • It involves the transfer of washed sperms and harvested ova to the ampulla of the fallopian tube with the help of a laparoscope. Fertilization and cleavage occur in the fallopian tube.
  • This method involves the transfer of an ovum collected from a donor female into another female who cannot produce ova but can provide suitable conditions for fertilization and further development of the Foetus through parturition.

3.Intra-Cytoplasmic Sperm Injection (ICSI)
In this method, the sperm is directly injected into the ovum to form an embryo in the laboratory and then embryo transfer is carried out.
4.Artificial Insemination
In this method, the sperm collected from the husband or healthy donor is artificially introduced into the vagina or into the uterus. It is called Intra uterine insemination (IUI).
This method is used in cases where infertility is due to the inability of the male partner to inseminate the female or due to the very low sperm count in the ejaculates.


Amniocentesis


  • A sample of amniotic fluid from the womb of a pregnant woman is taken during the early stage of Foetal development and the cells are cultured and analyzed.
  • By this method the chromosomal abnormalities, the sex of the Foetus and developmental disorders could be detected.
  • It is misused, for destroying the normal female Foetus. (female foeticides).



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